N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and OrthopedicsВестник травматологии и ортопедии им. Н.Н. Приорова0869-86782658-6738Eco-Vector32138810.17816/vto321388Original study articlesОригинальные исследованияResearch ArticleComparison of the treatment results of humerus diaphysis post-traumatic false joints using vascularized bone grafts with and without a monitor skin flap: Retrospective cohort studyСравнение результатов лечения посттравматических ложных суставов диафиза плечевой кости с использованием васкуляризованных костных трансплантатов с мониторным кожным лоскутом и без него: ретроспективное когортное исследованиеhttps://orcid.org/0000-0002-1291-5094GolubevIgor O.ГолубевИгорь Олегович
Russian Federation

MD, PhD, Dr. Sci. (Med.), Head of the department of microsurgery and hand injury

доктор медицинских наук, врач травматолог-ортопед, заведующий отделением микрохирургии и травмы кисти

iog305@mail.ruhttps://orcid.org/0009-0009-8088-2309SarukhanyanAnna R.СаруханянАнна Робертовна
Russian Federation

traumatologist-orthopedist

врач травматолог-ортопед, кафедра травматоологии и ортопедии

annesr@mail.ruhttps://orcid.org/0009-0004-9362-3449MerkulovM. V.МеркуловМаксим Владимирович
Russian Federation

MD, Dr. Sci. (Med.), traumatologist-orthopedist

доктор медицинских наук, врач травматолог-ортопед, старший научный сотрудник отделения микрохирургии и травмы кисти

hand-clinic@mail.ruhttps://orcid.org/0009-0002-0051-2666BushuevOleg M.БушуевОлег Михайлович
Russian Federation

MD, Cand. Sci. (Med.), traumatologist-orthopedist

кандидат медицинских наук, врач травматолог-ортопед, старший научный сотрудник отделения микрохирургии и травмы кисти

bushuev_oleg@mail.ruShiryaevaGalina N.ШиряеваГалина Николаевна
Russian Federation

MD, Cand. Sci. (Med.), traumatologist-orthopedist

кандидат медицинских наук, врач травматолог-ортопед

hand-clinic@mail.ruhttps://orcid.org/0009-0001-3802-2577KutepovIl'ya A.КутеповИлья Александрович
Russian Federation

MD, Cand. Sci. (Med.), traumatologist-orthopedist

кандидат медицинских наук, врач травматолог-ортопед отделения микрохирургии и травмы кисти

kutepov_cito@mail.ruhttps://orcid.org/0000-0003-1745-8010KuznetzovVasiliy D.КузнецовВасилий Дмитриевич
Russian Federation

graduate student, traumatologist-orthopedist

аспирант, врач травматолог-ортопед

Dr.kuznetsovvd@gmail.comPriorov National Medical Research Center of Traumatology and OrthopedicsНМИЦ травматологии и ортопедии им. Н.Н. ПриороваRussian Peoples’ Friendship UniversityРоссийский университет дружбы народов18052023270620233015141603202306042023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://journals.eco-vector.com/0869-8678/article/view/321388

BACKGROUND: The use of the microvascular flap in reconstructive surgery of complicated nonunions of the diaphysis of the humerus is highly valuable. Flaps with compromised blood supply are possible in up to 10% of cases and often lead to the failure of vascularized reconstruction. The combined skin + bone graft is a simple, useful, and reliable option for flap vitality control with a high success rate.

OBJECTIVE: To compare microvascular grafting with versus without monitoring the skin flap.

MATERIALS AND METHODS: Forty-one microvascular grafting was performed from 2010 to 2017 in patients with humeral non-union and bone defects in the Department of Microsurgery and Trauma of the Hand of Priorov National Medical Research Center of Traumatology and Orthopedics. A combined skin bone flap was used in 23 (56%) patients, and in 18 (44%) patients, grafting was performed without monitoring the skin flap Computed tomography and X-ray imaging were used to monitor non-union healing. The use of a signal skin flap is an effective way to control blood flow in the graft and improves treatment results.

RESULTS: In the group without monitoring of the skin flap, non-union healing was documented in 14 (77%) cases. In the group with monitoring of the skin flap, nonunion healing occurred in 22 (96%) cases.

CONCLUSION: Monitoring the skin flap is an effective option to ensure microvascular flap blood supply control and improves the outcomes in humeral nonunion healing.

Обоснование. Применение микрососудистых лоскутов в реконструктивной хирургии имеет высокую актуальность в лечении осложнённых ложных суставов диафиза плечевой кости. Нарушение кровоснабжения анастомоза происходит в 5–10% случаев, что может привести к гибели трансплантата. Использование комбинированного кожно-костного лоскута является простым, доступным и достаточно надёжным способом контроля лоскута, повышающим вероятность успеха операции.

Цель. Сравнить эффективность кровоснабжаемой костной пластики с использованием сигнального кожного лоскута и без него.

Материалы и методы. В отделении микрохирургии и травмы кисти ФГБУ НМИЦ ТО им. Н.Н. Приорова (Москва) в период с 2010 по 2017 год было проведено оперативное лечение 41 пациента с ложными суставами и дефектами плечевой кости с использованием васкуляризованных костных трансплантатов. Из них у 23 (56%) человек костный лоскут применён в комбинации с мониторным кожным лоскутом на перфорантных сосудах, у 18 (44%) пациентов сигнальный кожный лоскут не использовали. Оценку результатов проводили на основании данных рентгенологического исследования и компьютерной томографии.

Результаты. При отсутствии мониторного кожного лоскута консолидация наступила у 14 (77%) пациентов из 18, при его наличии консолидация была достигнута у 22 (96%) человек из 23.

Заключение. Применение сигнального кожного лоскута является эффективным способом контроля кровотока в трансплантате и улучшает результаты лечения.

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